Malnutrition in the Sahel / La malnutrition au Sahel

In 2006 and 2007, UNICEF supported a series of national Nutrition and Child Survival surveys and in-depth reviews in Burkina Faso, Chad, Mali, Mauritania and Niger to assess child nutrition throughout the Sahel.

Summary of the major findings of these surveys and reviews

• The Sahel has some of the highest child mortality rates in the world. The regional underfive mortality rate in the Sahel is 222 per 1,000 live births (i.e. 600,000 child deaths annually). This means that one in five Sahelian children dies before age five.• The Sahel has some of the highest acute malnutrition rates in children worldwide. The latest available surveys in these five countries show that 1.5 million children under five years of age suffer from acute malnutrition. • Acute malnutrition is affecting primarily infants and young children. Over 80% of underfives with acute malnutrition are young children under three. An estimated 18% of children under three (i.e. 1.1 million children) suffer from acute malnutrition.• The prevalence of acute malnutrition in the region is over emergency thresholds.According to WHO, when the prevalence of acute malnutrition in children 6 to 59 months old is greater than 10% the nutrition situation of children is considered serious; when it is greater than 15% the nutrition situation of children is considered critical. In the Sahel, the regional prevalence of acute malnutrition is 14.5%. • Chronic malnutrition in children is widespread and severe. An estimated 40% of underfives (i.e. 4 million children) suffer from chronic malnutrition. Moreover, 50% of underfives who are chronically malnourished suffer from severe chronic malnutrition. • In the Sahel, malnutrition is an associated cause of 56% of child deaths. This means that more than half the child mortality burden in the Sahel is attributable to child malnutrition, which causes over 300,000 child deaths annually.• Rates of malnutrition in children have remained over critical levels for at least a decade. These stagnant prevalence figures combined with rapid population growth translate into a 40 to 50% increase in the absolute number of malnourished children over the last ten years.• Child malnutrition is not limited to rural areas; children living in urban areas are equally affected. National surveys showed a high prevalence of malnutrition in city centers. In Ouagadougou and N’Djamena, up to 16% of underfives suffer from acute malnutrition. • Child malnutrition is not limited to food insecure areas. Very high rates of child malnutrition are found in regions not classified as food-insecure. For example, in Niger (2005), some of the highest rates of acute malnutrition in children were found in Zinder, a region classified among those with the lowest proportion of food-insecure households.

Determinants of malnutrition in the SahelIn the Sahel, the major determinants of child malnutrition include: 1. Inadequate food and feeding practices in the first two years of life (breastfeeding and complementary foods and feeding practices); 2. Poor care practices for infants, young children and women particularly during pregnancy and lactation; 3. High morbidity levels and poor access to essential health services, safe drinking water and a healthy environment; 4. Women’s lack of access to education, life-saving information, and decision-making power. This leads to a vicious cycle of malnutrition and disease, the cause of unacceptably high child mortality, ill growth and poor development. Therefore, we have all the evidence we need to assert that in the Sahel, a nutrition crisis in children is underway. This region wide nutrition crisis in children requires an urgent and effective response to ensure that a range of evidence-based, low-cost, high impact interventions essential to child nutrition and survival are delivered at national scale through a combination of facility-based, outreach, and community-based implementation schemes.

Key interventions to respond to and prevent malnutritionThese essential interventions are three pronged:• Food and feeding practices• Health, hygiene and care practices• Education, information and support.

These essential interventions are meant to prevent that children become malnourished and to care for malnourished children.

Prevention and care are achieved through improved:• Prenatal nutrition for low birth weight prevention• Breastfeeding practices in the first two years of life• Complementary foods and feeding practices in the first two years of life• Micronutrient nutrition in early childhood and during pregnancy and lactation• Anemia control in early childhood, during pregnancy and lactation• Feeding and care for children with severe malnutrition• Women’s education and access to information and decision-making capacity.

Policy implications to reach MDG 1 and 4If the Millennium Development Goals to reduce child malnutrition rates by half and child mortality rates by two-thirds between 1990 and 2015 are to be reached in the Sahel, changing the status quo and tackling unacceptable levels of child malnutrition needs to become a policy, programme and investment priority.

National Governments need to be in the driving seat, as the primary responsibility in the fight against child malnutrition is theirs. National governments need to acknowledge the unacceptable nutrition situation of children and act upon it through adequate and sustained policy and programme action, including the allocation of appropriate human and financial resources. United Nations agencies, humanitarian and development partners and international financial institutions need to support national efforts to prioritize the fight against child malnutrition in national development frameworks and budgets. Finally communities and community resource persons need to be involved as agents of change.

Stories from the fieldThe stories from Burkina Faso, Chad, Mali, Mauritania and Niger of the series "Malnutrition in the Sahel" demonstrate that we know what needs to be done in the fight against child malnutrition in the Sahel, we know how to do it, and we know that it works; the challenge now is to deliver these interventions on a national scale so that no child in the Sahel is denied the right to nutrition and life. The time for complacency is over. This is the time to act.